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Addressing the growing “silver lining” sentiment of some on the Left that Obamacare’s troubles might regenerate support for a single payer system, TAP’s Paul Waldman issues a warning that is well worth hearing:

[A] “failure” of the ACA would likely be greeted with the general sentiment that it didn’t help as much as people hoped. Would it then be possible to assemble the kind of political momentum necessary to pass single-payer? That seems all but impossible. Keep in mind that meaningful health insurance reform had behind it an almost unanimous Democratic party for decades before it was finally achieved. What it finally took was a worsening of key trends like premium costs and rates of uninsurance, combined with the momentary possession of big enough congressional majorities to overcome Republican obstruction, combined with the co-opting of the powerful interests that traditionally opposed reform. It wasn’t as though Barack Obama woke up one day and decided he’d like to reform health care; the work, including devising the plan he adopted, had been done long before he came to Washington.

So let’s say it’s five years from now, and the most likely thing has occurred: the ACA is working well in some areas and less well in others, and liberals like me are still saying that single-payer would be better. Even if it was worse than that, could you assemble that same unanimity on the Democratic side to push for it? Almost certainly not. Could you stand up to the fierce opposition of interest groups like insurers and pharmaceutical companies and device makers and doctors? Probably not. Will you have the filibuster-proof majority in the Senate (don’t forget, the “nuclear option” only eliminated the filibuster for some judicial and executive branch nominations, but left it intact for legislation) that would be necessary? Odds are exceedingly slim.

If we’re going to see something like single-payer in our lifetimes, chances are it will come not from a grand reform but through a series of smaller adjustments to the current system.

I agree. Another way to put the argument Waldman is making is that it took an extraordinary confluence of events—including a 2008 Democratic presidential nominating contest in which competing universal health plans were the center of attention and a 2008 election result that gave Democrats a very brief “trifecta” of real control of the House and Senate and White House—to make any health reform action possible. The votes weren’t there for a single payer plan then, and it’s hard to imagine them suddenly materializing now because a Democratic health reform law is unpopular.

Ed Kilgore
is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

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